Bi Syndrome – Treatment of pain with Acupuncture

“Painful Obstruction Syndrome” indicates pain, soreness or numbness of muscles, tendons and joints from invasion of external Wind, Cold or Dampness.

Painful Obstruction Syndrome is called “Bi”, which evokes the idea of “obstruction”. In Chinese medicine it means pain, soreness or numbness due to obstruction in the circulation of Qi and Blood in the channels caused by invasion of exterior Wind, Cold or Dampness.

The invasion of external climatic factors is due to a pre-existing and temporary deficiency of the body’s Qi and Blood which allows the Wind, Cold and Dampness to penetrate.

The “Discussion on the Origin of All Illnesses” (AD 610) says:
Painful Obstruction Syndrome is due to the combined invasion of Wind, Cold and Dampness, causing swelling and pain. It is due to a weak body condition and the space between skin and muscles being open, which allows the Wind to penetrate.

The “Treatment Strategies for Assorted Syndromes” (1839) says:
Painful Obstruction Syndrome … is due to deficiency of Nutritive and Defensive Qi and to the space between skin and muscles being open, thus allowing Wind-Cold-Dampness to ride the deficiency. Qi becomes obstructed by the pathogenic factors, it cannot circulate, it stagnates, Qi and Blood congeal, and in time Painful Obstruction Syndrome develops.

☯ The relative strength of the climatic pathogenic factors and the body’s Qi at any given time is crucial to the development of Painful Obstruction Syndrome.

☯ It is only when the climatic factors are temporarily and relatively stronger than our body’s Qi, that they become pathogenic and cause Painful Obstruction Syndrome.

☯ It is important to stress however, that the deficiency of body’s Qi necessary for the development of Painful Obstruction Syndrome is only relative, i.e. in relation to the strength of climatic pathogenic factors. It is not an absolute deficiency, otherwise that would mean that anyone who develops Painful Obstruction Syndrome suffers from deficiency of Qi or Blood, which is not the case. Thus, Painful Obstruction Syndrome is an affliction of the channels alone, not the internal organs.

☯ Painful Obstruction Syndrome is by definition an affliction of the channels rather than the internal organs. The pain and soreness are caused by obstruction in the circulation of Qi and Blood in the channels by exterior Wind, Cold or Dampness.

☯ The Stream (Shu) point is the point at which external pathogenic factors such as Cold, Dampness and Wind penetrate the channel. It is also the point of concentration of Defensive Qi.

☯ The River (Jing) point is the point from which pathogenic factors are deviated to joints and sinews where they settle. This is why pathogenic factors can settle in a joint for a long time without penetrating deeper and affecting the internal organs.

☯ The Connecting (Luo) point is the starting point of the Connecting channel. Since these channels flow in the surface affecting muscles and sinews, the Connecting point has an important application in the treatment of Painful Obstruction Syndrome.

☯ Within the flow of Qi dynamics, joints are important areas of convergence of Qi and Blood. Through joints, Yin- and Yang-Qi meet, Exterior and Interior converge and Qi and Blood enter and exit. Joints are also the places where pathogenic factors converge after penetrating the channels, causing obstruction to the flow of Qi and hence local stagnation of Qi and Blood. This stagnation accounts for the pain caused by external pathogenic factors in Painful Obstruction Syndrome.

☯ Invasion of pathogenic factors is made easier if the body condition is weak leading to malnourishment of the joints. It is also made easier if the joints are weakened by overuse through work or certain sports. In these cases, the external pathogenic factors penetrate the body and settle in the joints more easily due to the pre-existing condition of deficiency of Qi and Blood.

☯ When the Defensive Qi is deficient and the body condition is weak, the space between skin and muscles is said to be “open” and thus prone to invasion of Wind, Cold and Dampness.

Aetiology

☯ This is by definition invasion of external pathogenic factors such as Wind, Cold or Dampness.
Wind is the most pernicious of all pathogenic factors and one that is almost always combined with the others. Exposure to wind is an extremely important cause of Painful Obstruction Syndrome.

☯Painful Obstruction Syndrome can of course develop also from exposure to other conditions, such as sitting on damp surfaces, wading in water, living in a damp environment.

Although the only aetiological factor in Painful Obstruction Syndrome is weather, there are other predisposing factors.

☯Excessive sport or work activities
e.g. excessive aerobic exercise or jogging may put a strain on the spine and lead to backache.

☯ The constant repetition of a certain movement in one’s work is an obvious predisposing factor too, as this causes stagnation of Qi and Blood in an area which becomes more prone to invasion of exterior pathogenic factors.

☯ An underlying deficiency of Blood or Yin which leads to mal-nourishment of the channels so that they become prone to invasion of external pathogenic factors.

Particularly in chronic Painful Obstruction Syndrome or in the elderly, an underlying deficiency of Blood or Yin is nearly always a factor. In treatment, it is important not only to expel Wind, Cold or Damp, but also to nourish Blood or Yin.

☯ Accidents – create weakness which leads to easy invasion.

☯ Emotional problems are also contributing factors in the origin of Painful Obstruction Syndrome. Either by causing stagnation of Qi (such as from anger or resentment) which affects the channels, or by causing depletion of Qi and Blood (such as from sadness, grief and shock) which leads to mal-nourishment of the channels.

Differentiation

There are three main types according to causative factor.

1. Wind Painful Obstruction Syndrome (or Wandering Painful Obstruction Syndrome)
This is caused by Wind and is characterized by soreness and pain of muscles and joints, limitation of movement, with the pain moving from joint to joint. In acute cases the pulse would be Floating and slightly Rapid.

2.Damp Painful Obstruction Syndrome (or Fixed Painful Obstruction Syndrome)
This is caused by Dampness and is characterized by pain, soreness and swelling in muscles and joints with a feeling of heaviness and numbness of the limbs, the pain being fixed in one place and aggravated by damp weather. In acute cases the pulse would be Slow and slightly Slippery.

3.Cold Painful Obstruction Syndrome (or Aching Painful Obstruction Syndrome)
This is caused by Cold and is characterized by a severe pain in a joint or muscle with limitation of movement, usually unilateral. In acute cases the pulse is Tight.

1.2.3. Heat Painful Obstruction Syndrome
This originates from any of the previous three types when the exterior pathogenic factor turns into Heat in the Interior and gives rise to Heat Painful Obstruction Syndrome. This happens especially with an underlying deficiency of Yin.
It is characterized by pain and heat in the joints which feel hot to the touch, redness and swelling of joints, limitation of movement and severe pain. In acute cases there would be thirst, a fever which does not abate after sweating and a Slippery and Rapid pulse.
In this case, sweating does not bring the temperature down or reduce the pain because it is due to Damp-Heat. Thus, this syndrome is characterized not just by Heat, but Damp-Heat. In fact, Dampness is the primary aspect of this syndrome and Heat the secondary one.

Bone Painful Obstruction Syndrome
This only occurs in chronic cases and develops from any of the previous four types. Persistent obstruction of the joints by pathogenic factors leads to retention of body fluids which turn into Phlegm which further obstructs the joints and channels. This leads to muscular atrophy and swelling and deformity of the bones in the joints, which is an extreme form of Phlegm. At this stage, Painful Obstruction Syndrome becomes an interior syndrome affecting not only muscles, joints and channels, but also the internal organs.

☯ The obstruction in the circulation of Qi, Blood and Body Fluids caused by Phlegm may lead to stasis of Blood. The stasis of Blood in the channels further obstructs proper circulation and therefore is another cause of pain.The ache then becomes more or less constant and more severe.

☯ Deficiency of the Liver and Kidneys. It is this deficiency that allows the retention of Phlegm and stasis of Blood. Liver-Blood nourishes the sinews and when the Liver is deficient the sinews and tendons are not nourished, which leads to ache and stiffness of joints. The Kidneys nourish bones and when they are deficient the bones are deprived of nourishment and this allows Phlegm to build up in the joints in the form of swellings.

To sum up, the factors which may be present in chronic Painful Obstruction Syndrome are as follows:

(i) a general deficiency of Qi and Blood which predisposes the body to invasions of external pathogenic factors

(ii) the formation of Phlegm in the joints in the form of swellings due to improper transformation of Body Fluids

(iii) stasis of Blood due to the long-standing obstruction in the circulation of Blood caused both by the external pathogenic factors and by Phlegm

(iv) deficiency of Liver and Kidneys which leads to mal-nourishment of sinews and bones, the former causing ache and stiffness, the latter contributing to the settling of Phlegm in the joints.

To summarize the five types of Painful Obstruction Syndrome:

1. Wind Painful Obstruction Syndrome: pain moving from joint to joint
2. Damp Painful Obstruction Syndrome: fixed pain with soreness, heaviness, numbness and swelling of the joints
3. Cold Painful Obstruction Syndrome: severe pain in one joint
4. Heat Painful Obstruction Syndrome: very severe pain, hot-red-swollen joints
5. Bony Painful Obstruction Syndrome: painful joints with swelling and bone deformities.

Yellow Emperor’s Classic of Internal Medicine It says:

The 5 Yin organs are related to the five tissues where a chronic disease can lodge itself.
In Bone Painful Obstruction Syndrome the pathogenic factor reaches the Kidneys
In Sinew Painful Obstruction Syndrome it reaches the Liver
In Blood Vessel Painful Obstruction Syndrome it reaches the Heart
In Muscle Painful Obstruction Syndrome it reaches the Spleen
In Skin Painful Obstruction Syndrome it reaches the Lungs.

It then says:
Painful Obstruction Syndrome in the bones is serious
In the sinews it causes stiffness,
In the blood vessels it leads to Blood stasis
In the muscles it leads to weakness
In the skin it causes Cold.

When Painful Obstruction Syndrome affects the organs it causes death, when it is situated in the bones or sinews it becomes chronic, when it is situated in the muscles or skin it easily goes.

Treatment

☯ The aim of the treatment is simply to expel the pathogenic factors which have invaded the channels, and eliminate the resulting local stagnation of Qi and Blood in the channels.

Two important principles in the treatment of Painful Obstruction Syndrome:

1. It is usually necessary to expel all three pathogenic factors

2. It is also necessary to treat the internal organs. This means treating Blood (i.e. the Liver) in the case of Wind, tonifying Fire (i.e. Kidney-Yang) in the case of Cold and strengthening the Spleen in the case of Dampness.

When pathogenic factors invade the body to cause Painful Obstruction Syndrome, they will go through the skin, the space between skin and muscles, the channels, the sinews and the bones. The Liver nourishes the sinews and the Kidneys the bones: thus the strength of sinews and bones depends on the nourishment, not only of Blood and Essence of the Liver and Kidneys, but also on the evaporation of fluids by Kidney-Yang which leads to the formation of synovial fluid. When Liver and Kidneys are weak, Blood and Essence are depleted, Kidney-Yang cannot evaporate fluids, the Defensive Qi is feeble and external pathogenic factors invade the body causing Painful Obstruction Syndrome

Strengthening the Governing Vessel reinforcing (also with moxa) points along this vesse Du-4 , Du-12 and Du-14 , and opening the vessel with the points S.I.-3 and BL-62. A particular combination to warm Yang and strengthen the Governing Vessel is direct moxa on Ren-4 and Du-14

Acupuncture Points

In general, the treatment is based on the choice of points from four possible groups:

1. distal points
2. local points (including Ah Shi points)
3. adjacent points
4. points according to pattern
5. general points.

Distal Points

The main distal points for Painful Obstruction Syndrome according to channels are:

Lungs: LU-7
Large Intestine: L.I.-4
Stomach: ST-40
Spleen: SP-5
Heart: HE-5
Small Intestine: S.I.-3
Bladder: BL-60
Kidneys: KI-4
Pericardium: P-6
Triple Burner: T.B.-5
Gall-Bladder: G.B.-41
Liver: LIV-5.

Distal Point

Neck: G.B.-39, S.I.-3 , T.B.-5 , T.B.-8 , Bl-60 . Secondary points: ST-40 and KI-4 .
Shoulder: T.B.-5 , L.I.-4 , LU-7 , T.B.-1, L.I.-1 , ST-38 , BL-58 .
Elbow: L.I.-4 , T.B.-5 , L.I.-1 .
Wrist: ST-36 , SP-5 , G.B.-40 .
Fingers: no distal points (see above).
Lower back: BL-40 , BL-60 , BL-59 , BL-62 .
Sacrum: BL-40 , BL-58 .
Hip: G.B.-41 , BL-62 .
Knee: SP-5 , S.I.-5 .
Ankle: no distal points.
Toes: L.I.-4 .

Local Points

Neck: BL-10 , G.B.-20 .
Shoulder: L.I.-15 , T.B.-14 , Jianneiling (extra-point).
Elbow: L.I.-11 , T.B.-10 , S.I.-8
Wrist: T.B.-4 , L.I.-5 , S.I.-5 , S.I.-4 , P-7 .
Fingers: T.B.-3 , L.I.-3 , Baxie (extra points).
Lower back: BL-23 , BL-26 , BL-25 , BL-24 , Shiqizhuixia (extra point), Du-3 .
Sacrum: BL-32, Shiqizhuixia, BL-27 , BL-28 .
Hip: G.B.-30 , G.B.-29 .
Knee: Xiyan (extra points), ST-36 , SP-9 , LIV-7 , LIV-8, KI-10 , G.B.-34 , BL-40, SP-10 .
Ankle: SP-5 , G.B.-40 , ST-41 , BL-60.
Toes: Bafeng (extra points), SP-3 .

Ah Shi points

Adjacent Points

Neck: G.B.-21, Du-14 , BL-11 .
Shoulder: S.I.-9 , S.I.-10 , S.I.-11, S.I.-12, S.I.-13, S.I.-14 , S.I.-15, T.B.-15 , G.B.-21 , L.I.-14, T.B.-13 .
Elbow: L.I.-13, L.I.-10 , L.I.-14 .
Wrist: T.B.-5 , LU-7 .
Fingers: T.B.-5 .

Lower back: no adjacent points.

Sacrum: BL-23 .

Hip: G.B.-31 .

Knee: SP-10 , ST-34 .

Ankle: KI-7 , G.B.-34 , ST-36 .

Toes: SP-4 , ST-41, G.B.-34 , SP-9 .

Points According to Pattern

Wind Painful Obstruction Syndrome

BL-12 , G.B.-31 , G.B.-39 , Du-14 , T.B.-6 , BL-17 , BL-18 . All these points expel Wind, apart from the last two which nourish Blood and are chosen according to the principle of “nourishing Blood in order to extinguish Wind”.

In acute cases, one uses the reducing method and in chronic cases the even method.

The “Compendium of Acupuncture” suggests :

Wind Painful Obstruction Syndrome: LU-5 & GB-38
Cold Painful Obstruction Syndrome: ST-36 , Ren-6 , S.I.-5 , Bl-10 , Du-14 , Du-3 , BL-23 , Ren-4
In this case, one uses the reinforcing method and moxa. Moxa on the needle is the best form of moxibustion for Cold Painful Obstruction Syndrome. It combines the benefit of needling with that of the heat penetrating the muscle and joint via the needle.

Cold Painful Obstruction Syndrome: L.I.-11 Quchi, LU-7 , G.B.-30 , G.B.-31, BL-40, SP-5 , LIV-4 , G.B.-41.

Damp Painful Obstruction Syndrome
SP-9, SP-6 , G.B.-34 , ST-36 , BL-20.
Use the reducing method in acute cases and even method in chronic ones. BL-20 should be reinforced in either case. Moxa is also applicable

Heat Painful Obstruction Syndrome
ST-43 , L.I.-4 , L.I.-11, Du-14 .
Use the reducing method in acute cases and even method in chronic ones. Positively no moxa.

Bone Painful Obstruction Syndrome
BL-11 and G.B.-39 , with even method.

Chronic Painful Obstruction Syndrome

Qi-Blood Deficiency
Reinforce ST-36, SP-6 , Ren-4 , LIV-8 , BL-20 and BL-23 .

Phlegm in Joints
ST-40 , SP-9 , SP-6 , Ren-12, Ren-9, BL-20.
Ren-12 and BL-20 should be reinforced, while all the others should be reduced or needled with even method.

Stasis of Blood
SP-10 , BL-17 , P-6 , SP-6 , L.I.-11, all with reducing or even method.

Deficiency of Liver and Kidneys
Reinforce LIV-8 , KI-3 , SP-6 , G.B.-39 , BL-18 , BL-23 , Ren-4 , BL-11, G.B.-34 , ST-36 .

General Points

Wind: nourish Blood with BL-17 .
Cold: tonify Yang with Du-14 (direct moxa) and BL-23 .
Dampness: tonify the Spleen with BL-20 .